When Should Patients With Diabetes Eat?

From medpagetoday.com

By Hana Kahleova, MD, PhD

Meal timing may be an underused tool

For decades, nutrition counselling in diabetes care has focused primarily on one question: What should patients eat? But a growing body of evidence suggests another question may be clinically important as well: When should patients eat?

Human metabolism follows a circadian rhythm that influences insulin sensitivity, glucose tolerance, beta-cell responsiveness, and energy metabolism across the day. In the morning, metabolic efficiency is generally higher. As the day progresses, glucose tolerance declines and postprandial responses often worsen.

Yet, many patients consume their largest meals in the evening or eat across prolonged daily time windows extending from early morning into late night. From a circadian perspective, this pattern may create a mismatch between food intake and underlying metabolic biology.

Accumulating evidence suggests this mismatch matters.

Controlled feeding studies have demonstrated that identical meals consumed earlier in the day often produce lower postprandial glucose excursions compared with evening intake. Late eating has been associated with impaired glycaemic control, increased insulin resistance, and higher cardiometabolic risk.

In a randomized crossover study my colleagues and I conducted in patients with type 2 diabetes, two larger meals consumed earlier in the day -- breakfast and lunch -- produced greater reductions in body weight, hepatic fat content, fasting glucose, and insulin resistance than six smaller meals of identical caloric content distributed throughout the day.

Similarly, Elizabeth Sutton, PhD, and colleagues demonstrated that early time-restricted feeding improved insulin sensitivity, blood pressure, and oxidative stress markers even without weight loss in men with prediabetes.

These findings suggest that meal timing may influence metabolic outcomes independently of caloric intake alone. Yet, meal timing remains largely absent from routine diabetes care.

Current nutrition counselling appropriately emphasizes dietary quality, caloric balance, fibre intake, and reduction of ultra-processed foods. But patients are rarely advised about circadian alignment, eating windows, or the metabolic implications of late-night intake. This may represent a missed clinical opportunity.

Importantly, meal timing interventions are relatively low-cost, scalable, and behaviourally straightforward compared with many other therapeutic approaches. They do not require additional medications, devices, or invasive procedures. In some patients, they may complement pharmacologic therapies by improving underlying metabolic physiology rather than bypassing it.

This is particularly relevant at a time when healthcare systems are confronting rising rates of obesity and type 2 diabetes alongside escalating demand for costly metabolic therapies, including GLP-1 receptor agonists.

Meal timing is unlikely to replace established pharmacologic treatment. Nor should circadian-based nutrition be oversimplified into rigid dietary rules. Individual variability remains substantial, and more long-term randomized trials are still needed. But the broader principle is increasingly difficult to ignore: metabolism is not static across the day.

As clinicians, we routinely consider timing in other domains of medicine. We time antihypertensives, insulin administration, corticosteroids, chemotherapy, and sleep interventions according to physiologic rhythms and therapeutic response. Nutrition may deserve similar consideration.

Incorporating circadian principles into dietary counselling does not require abandoning existing nutrition recommendations. Rather, it may strengthen them by aligning food intake more closely with human metabolic biology.

For many patients with insulin resistance and type 2 diabetes, the future of nutrition therapy may involve not only improving food quality -- but improving temporal alignment as well. And that shift may turn out to be clinically meaningful.

https://www.medpagetoday.com/opinion/second-opinions/121600

Scientists discovered something surprising about french fries and diabetes

From sciencedaily.com

French fries may be driving potatoes’ bad reputation, while other potato dishes seem far less risky for type 2 diabetes

Summary:

French fries may be the real potato problem. A large study tracking more than 205,000 people for nearly 40 years found that eating three servings of fries per week was linked to a 20% higher risk of developing type 2 diabetes, while baked, boiled, or mashed potatoes showed no significant increase in risk. The research also found that swapping potatoes for whole grains lowered diabetes risk, while replacing them with white rice had the opposite effect.

French fries have long been criticized as an unhealthy food choice, and new research suggests they may deserve that reputation more than other potato dishes.

A large study published in The BMJ found that eating three servings of French fries per week was associated with a 20% higher risk of developing type 2 diabetes. In contrast, consuming the same amount of potatoes prepared in other ways, such as boiled, baked, or mashed, was not linked to a significant increase in diabetes risk.

The research also found that what replaces potatoes in a person's diet matters. Swapping potatoes for whole grains was associated with a lower risk of type 2 diabetes, while replacing them with white rice was linked to a higher risk.

French fries stood out in a massive long-term study, with three weekly servings linked to a 20% higher risk of type 2 diabetes. Credit: Shutterstock

Looking Beyond Potatoes Alone

Potatoes provide important nutrients, including fibre, vitamin C, and magnesium. However, they are also rich in starch and have a relatively high glycaemic index, meaning they can cause blood sugar levels to rise quickly. Because of this, previous studies have often connected potato consumption to a greater risk of type 2 diabetes.

Yet researchers noted that two important factors have often been overlooked. First, potatoes can be prepared in very different ways. Second, the health effects of potatoes may depend on which foods people eat instead.

To explore those questions, scientists examined whether diabetes risk differed between French fries and potatoes prepared by boiling, baking, or mashing. They also evaluated the potential effects of replacing potatoes with other common carbohydrate-rich foods, including whole grains and rice.

Four Decades of Health Data

The study drew on data from more than 205,000 U.S. health professionals who participated in three major long-term studies conducted between 1984 and 2021.

At the start of the research, participants did not have diabetes, heart disease, or cancer. Every four years, they completed detailed dietary questionnaires that allowed researchers to track eating habits over time.

During nearly 40 years of follow-up, 22,299 participants developed type 2 diabetes.

After accounting for lifestyle habits and dietary factors that could influence diabetes risk, researchers found that every three weekly servings of potatoes overall were associated with a 5% increase in the rate of type 2 diabetes.

The strongest association, however, involved French fries. Every three servings per week were linked to a 20% increase in the rate of type 2 diabetes. Similar consumption of baked, boiled, or mashed potatoes was not associated with a statistically significant increase.

Whole Grains Show a Benefit

Researchers also looked at what happened when potatoes were replaced with other foods.

Replacing three weekly servings of potatoes with whole grains was associated with an 8% lower rate of type 2 diabetes. When baked, boiled, or mashed potatoes were replaced with whole grains, the rate was 4% lower. Replacing French fries with whole grains was associated with a 19% lower rate.

The results were different when potatoes were replaced with white rice. Substituting either total potato intake or baked, boiled, or mashed potatoes with white rice was associated with a higher rate of type 2 diabetes.

Important Caveats

Because this was an observational study, it cannot prove that French fries directly cause diabetes. The researchers acknowledge that other factors not measured in the study may have contributed to the results.

The participants were also predominantly health professionals of European ancestry, which means the findings may not apply equally to all populations.

Even so, the researchers wrote: "Our findings underscore that the association between potato intake and type 2 diabetes risk depends on the specific foods used as replacement. The findings also align with current dietary recommendations that promote the inclusion of whole grains as part of a healthy diet for the prevention of type 2 diabetes."

Are Potatoes Back on the Menu?

In an accompanying editorial, researchers argued that potatoes should not be viewed as a single category when considering health effects.

They emphasized that both preparation methods and replacement foods are important factors when making dietary recommendations or shaping public policy.

According to the editorial, baked, boiled, and mashed potatoes can fit into a healthy and environmentally sustainable diet because of their relatively low environmental impact and overall nutritional value. However, the authors noted that whole grains should remain a priority food choice for reducing diabetes risk.

They also called for future studies involving more diverse populations and analyses that continue to examine both cooking methods and food substitutions.

https://www.sciencedaily.com/releases/2026/06/260603015218.htm

9 Tips for Camping and Hiking With Type 1 Diabetes

From everydayhealth.com

By Jessica Freeborn

If you have type 1 diabetes (T1D), hiking and camping can be a little more complicated. When you’re off in the wilderness, miles from doctors and roads, you’ll need to take special care of your insulin and medical equipment, and complications like low blood sugar (hypoglycaemia) can be especially dangerous. 

“Hiking can bring in so many extra factors to the mix that you might not be expecting when you're doing other types of exercising,” says the certified diabetes care and education specialist Jen Hanson, the executive director of Connected in Motion, a non-profit that organizes wilderness adventures for adults with type 1 diabetes. 

With a little extra planning, says Hanson, who has type 1 diabetes herself, you can have an enjoyable and safe time in the great outdoors.  

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1. Bring Backups for All Your Diabetes Supplies

It’s often recommended to double the amount of diabetes supplies you carry when traveling, and hiking and camping trips are no exception. For people with T1D who have an insulin pump, it may also be a good idea to bring a backup way to deliver insulin.

“Bring both long- and short-acting insulin, syringes or pen needles, and a backup glucagon kit,” says Rekha Kumar, MD, an endocrinologist at NewYork-Presbyterian and Weill Cornell Medicine. She also notes that people who use an insulin pump should bring backup insulin in case of pump malfunctions. 

“Some of the things that I see most commonly when hiking with people with diabetes are [CGM or pump] sites that get ripped out when backpacks are taken off or put on, [and] a lot of sweat that can lead to sites falling off,” Hanson says. 

2. Bring More Sugar Than You Think You’ll Need

Physical activity like hiking increases the risk of low blood sugar, and there are no grocery stores in the wilderness.

“It's probably a good idea to pack more [sugar] than you're going to need,” says Hanson, explaining that hikes can take longer than you expect. She encourages people to think about “the maximum duration of time that you might possibly be out there and pack accordingly.” 

Dr. Kumar adds that it can be a good idea to pack multiple forms of sugar, and you should also consider the environment where you’re hiking. Fruit gummies can freeze in cold weather, and glucose tablets can degrade or clump because of sweat and heat. “Bring gel packets because they’re more reliable in outdoor temperatures,” she says.

3. Inform Friends About Your Condition

Hiking partners play an important role in recognizing and responding to low blood sugar. “The companions that somebody is hiking or camping with should know what low blood sugar or hypoglycaemia looks like,” says Kumar. 

Visible symptoms of hypoglycaemia include:

• Shakiness
• Sweating
• Confusion
• Weakness
• Vision changes
• Slurred speech

Kumar says very low blood sugar may look like intoxication or altitude sickness, and just knowing there's a range of symptoms can be crucial in remote settings where quick recognition matters. 

It’s equally important your camping and hiking partners know how to respond during a low-blood-sugar event. Hanson says friends should understand in advance how you want them to help, including where your low blood sugar supplies are stored. Your friends should be prepared to find your sugar source and help you eat or drink it.

4. Pack Glucagon 

Glucagon is a medication used to treat low blood sugar levels so severe that you can no longer treat them yourself by simply eating or drinking something sugary. It works by signalling the liver to release stored glucose into the bloodstream. 

There are different forms of glucagon available, including a nasal spray or a pen that’s similar to an EpiPen, which Kumar says are preferable in outdoor settings, because they’re faster and easier to administer.

Ideally, you’d have someone on your trip that knows how to properly administer glucagon. “If the person is unable to swallow or loses consciousness, administering glucagon and contacting emergency services can be lifesaving. Clear, simple instructions shared in advance can support a quick and effective response,” says Barbara Eichorst, RD, CDCES, the vice president of healthcare programs at the American Diabetes Association.  

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5. Wear a Medical ID Bracelet

Medical ID bracelets or necklaces alert emergency personnel to conditions such as type 1 diabetes. An ID bracelet could help in a situation where you become unresponsive, such as with extremely low blood sugar.

“Wearing a medical identification bracelet or necklace that indicates type 1 diabetes and insulin use is strongly recommended,” says Eichorst. “In the event of an emergency, this can help others, including first responders, quickly understand the situation and provide appropriate care.” 

6. Adjust Insulin for Activity 

If you’re going to be walking, hiking, kayaking, or skiing for most of the day, you might need to dial down the amount of insulin you’re using, both before and after your workout.

“Aerobic exercise like hiking lowers blood sugar, and that can persist for 12 to 24 hours post exercise. Even the night after you hike, you're at risk of low blood sugar,” says Kumar. For people using insulin pumps, this may involve temporarily reducing basal insulin delivery, while those on injections may need to adjust both long-acting and mealtime doses, she says. 

Hanson says it may be helpful to “think about putting your basal rates back to normal about 30 minutes before you're about to end your hike to avoid a really big blood sugar spike at the end of the day.”

If you’re not familiar with making such adjustments on your own, it’s a good idea to discuss your plans with your doctor. 

7. Stay Hydrated and Fuelled

Consuming enough water is important when exercising and in hot and humid conditions. “Hydration is often overlooked, but is really key, and that's whether you have diabetes or not,” Hanson says. “So don't miss those opportunities to fill your water bottle.”

Don’t neglect proper nutrition either. “During the day, your body is using all the food you're eating for energy, but it's also breaking down energy that's been stored in your muscles for emergencies or just for long days like this,” says Hanson. “And those stores need to be replenished.”

It can be tricky to decide what to eat during a long day of exercise, because you have to contend with more blood sugar variables than normal. “Combining fast-acting carbohydrates for immediate needs with more sustained sources of energy, such as snacks that include carbohydrates and protein, can support stability,” says Eichorst, noting that “eating small amounts at regular intervals during longer hikes can also help maintain more consistent glucose levels.”

8. Take Care of Your Feet

A long hike can lead to foot problems for anyone, and it’s especially important to be proactive about foot health when you have diabetes, since nerve damage (peripheral neuropathy) can occur in both type 1 and type 2 diabetes. This nerve dysfunction can put people at a greater risk for injury and foot infections.

You can prevent blisters by choosing the right shoes and aggressively treating your feet as soon as you feel irritation. “If you're planning on buying a new pair of hiking boots, make sure you give yourself a lot of time to work them in, because a new boot on a long trail on a hot day is a recipe for blisters,” says Hanson. “Stop as soon as you feel rubbing or something feeling off, because fixing it immediately is a great way to stop blisters from happening.” 

When blisters do happen, prompt treatment is critical. “If a blister develops, keeping it clean and covered and monitoring for signs of infection can help support healing,” says Eichorst. 

9. Know When to Call It Quits

In some circumstances, it might be safest to cut a camping or hiking trip short. Kumar says the following scenarios may warrant ending a trip early. 

• Low blood sugar that isn’t responding to treatment
• Consistent high blood sugar with ketones, which would be an emergency like diabetic ketoacidosis (DKA)
• Nausea, vomiting, or being unable to keep food down
• Diabetes equipment failure
• Severe dehydration or symptoms of heat illness

It may also be important to consider your supplies. With repeated episodes of low blood sugar, “you may have consumed all or most of the treatments that you've brought along with you,” says Hanson. “And you still need emergency treatment for the way out.” 

With higher blood sugars, she says it’s possible to “get to a point where you might have used all of your pump sites, or your insulin has gone bad,” in which case ending a trip is the wisest choice. 

The Takeaway

• Hiking and camping with type 1 diabetes requires extra preparation: packing backup insulin, glucose sources, and diabetes supplies in case of emergencies or equipment failure.
• Physical activity, heat, altitude, and changing meal schedules can all affect blood sugar levels, making it important to monitor glucose closely and adjust insulin, hydration, and nutrition as needed.
• Let hiking companions know how to recognize and respond to low blood sugar, and don’t hesitate to end a trip early if blood sugar becomes unsafe or supplies run low.

https://www.everydayhealth.com/diabetes/tips-for-camping-and-hiking-with-type-1-diabetes/

What Is Type 3 Diabetes?

From goodrx.com 

Key takeaways:

• Type 3 diabetes is a term that describes the effects of diabetes in the brain. 

• People with diabetes have a higher risk of dementia. For some, the risk for dementia and diabetes may both be linked to their genetics.

• Caring for your diabetes is the best way to prevent or slow the progression of Type 3 diabetes, or diabetes-related dementia.

Many people know about Type 1 and Type 2 diabetes. But maybe you’ve also heard the term “Type 3 diabetes.” It’s not a new kind of diabetes, or a diagnosis you will see in your medical chart. It’s a term that describes the effects of diabetes on the brain. 

Here, we’ll talk about the connection between diabetes and dementia. And how you can lower your risks and optimize the health of both your body and your brain. 

What is Type 3 diabetes?

Most people with diabetes don’t have dementia. But they have a higher risk for it over time. People with Type 2 diabetes have a 40% to 60% greater chance of Alzheimer’s dementia. And the risk of vascular dementia is around 90% higher for people with Type 2 diabetes compared to people without diabetes.

In Type 2 diabetes, the cells in the body don’t use insulin effectively. That can lead to organ damage over time. Recent research shows that the same thing can happen to brain cells. Brain cells that have trouble using insulin don’t work as well as they should. That can result in problems with thinking and memory. Type 3 diabetes is a way to talk about the brain changes that happen for some people with Type 2 diabetes. 

Is Type 3 diabetes different from Alzheimer’s disease?

Type 3 diabetes isn’t the same thing as Alzheimer’s disease. But there’s still a connection between the two conditions.

Alzheimer’s disease is the most common cause of dementia. The biggest risk factor for Alzheimer’s is older age. But diabetes is a risk factor as well. 

There’s more to learn about the exact ways that diabetes affects brain cells. But people who have had high blood sugar for longer periods of time have a greater risk of dementia than those whose sugar levels are well managed. People who have more episodes of hypoglycaemia, or low blood sugar, also have a higher risk. 

Most studies on diabetes and dementia have looked at people with Type 2 diabetes, which is much more common than Type 1 diabetes. But one large review found that people with Type 1 diabetes may also have a 50% higher risk of dementia as they age. 

For some people, there may be a shared genetic risk for both Type 2 diabetes and Alzheimer’s disease. One gene, called APOE4, is a known risk factor for Alzheimer’s disease. It turns out that the same gene may affect how the brain uses insulin. 

People with Alzheimer’s disease are also more likely to develop Type 2 diabetes. Interestingly, researchers have also noticed that dementia in some people with diabetes progresses more slowly. And it looks a little different on tests like CT scans and MRIs. This subset of people often have more muscle loss and weakness, and may need to use more insulin. Research in this area may help to develop new kinds of treatment.

How is Type 3 diabetes different from other types of diabetes?

There are four main types of diabetes:

• Type 1 diabetes happens more often in children and young adults. It’s an autoimmune condition that damages the cells in the pancreas that make insulin. People with Type 1 diabetes have to use insulin every day. 

• Type 2 diabetes is more common in adults. The body’s cells don’t use insulin well, which leads to higher blood sugar. Type 2 diabetes is treated with diet, exercise, and medications that may or may not include insulin. 

• Gestational diabetes is high blood sugar that happens during pregnancy. Glucose levels may return to normal after pregnancy. But people with gestational diabetes have a higher risk for Type 2 diabetes later on.

• Other types that result from taking certain medications or having other medical conditions. These can sometimes lead to high blood sugar. Of note, diabetes that results from a pancreatic disease is sometimes called “Type 3c” diabetes. This isn’t the same as Type 3 diabetes. 

Type 3 isn’t a diagnosed form of diabetes. It’s a way to think about the insulin resistance and damage to brain cells that occur in some people with diabetes.

Can Type 3 diabetes be prevented or treated?

Yes, there are things you can do to prevent Type 3 diabetes. Caring for your diabetes lowers dementia risk.

Things you can do to lower your risks include:

• Aim for blood sugar levels within the target range: Blood glucose that is too high or too low is risky for brain cells.

• Manage blood pressure and cholesterol: These conditions often go along with Type 2 diabetes. Managing them also supports brain health.

• Eat a balanced and nutritious diet: Eating plans like the MIND diet, DASH diet, and Mediterranean diet all have evidence for both diabetes management and brain health.

• Stay active: Doing regular physical activity helps manage blood glucose and blood pressure. And it improves memory, focus, and mood.

• Ask about medications: If you have diabetes, talk with a healthcare professional about medications that might also support brain health. Some, including GLP-1s like semaglutide (Ozempic), may help lower the risk of dementia. 

• Avoid smoking and heavy alcohol use: Smoking and alcohol both increase the risk for Alzheimer’s disease. 

• Optimize your sleep: Getting at least 7 hours of quality sleep at night helps to protect brain cells.

• Keep your social connections active: People who have limited contact with others may have an increased risk of dementia.

• Get support for stress, anxiety, and depression: Treating depression can lower the risk of Alzheimer’s. And it can also improve symptoms for people who have dementia.

The bottom line

Type 3 diabetes isn’t something you’re diagnosed with. It’s a way to recognize and study the links between Type 2 diabetes and dementia. Genetics is a risk factor for both diabetes and dementia. But there are also many risk factors that can be modified. Good nutrition, an active lifestyle, and partnering with healthcare professionals can support the health of your brain and your body.

https://www.goodrx.com/conditions/diabetes/what-is-type-3-diabetes